A high burden of asymptomatic gastrointestinal infections in traditional communities in Papua New Guinea
- Authors: Horwood, Paul , Soli, Kevin , Maure, Tobias , Naito, Yuichi , Morita, Ayako , Natsuhara, Kazumi , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Tomitsuka, Eriko , Igai, Katsura , Larkins, Jo-Ann , Siba, Peter , Pomat, William , McBryde, Emma , Umezaki, Masahiro , Greenhill, Andrew
- Date: 2017
- Type: Text , Journal article
- Relation: American Journal of Tropical Medicine and Hygiene Vol. 97, no. 6 (2017), p. 1872-1875
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- Description: Stool samples were collected from 148 healthy adults living a traditional subsistence lifestyle in Papua New Guinea and screened for enteric pathogens using real-time RT-PCR/PCR assays. Enteric pathogens were detected in a high proportion (41%) of individuals. Clear differences were observed in the detection of pathogens between highland and lowland communities. In particular, there was a marked difference in detection rates of norovirus GII (20% and 0%, respectively) and Shigella sp. (15% and 0%, respectively). Analysis of the relationship between enteric pathogen carriage and microbial community composition of participants, using box plots to compare specific normal flora population numbers, did not suggest that gut microbial composition was directly associated with pathogen carriage. This study suggests that enteric pathogens are common in healthy individuals in Papua New Guinean highland communities, presumably acting as a reservoir of infection and thus contributing to a high burden of gastrointestinal illnesses.
Impact of intermittent preventive treatment in pregnancy with azithromycin-containing regimens on maternal nasopharyngeal carriage and antibiotic sensitivity of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus : A cross-sectional survey at delivery
- Authors: Unger, Holger , Aho, Celestine , Ome-Kaius, Maria , Wangnapi, Regina , Umbers, Alexandra , Jack, Wanda , Lafana, Alice , Michael, Audrey , Hanieh, Sarah , Siba, Peter , Mueller, Ivo , Greenhill, Andrew , Rogerson, Stephen
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Clinical Microbiology Vol. 53, no. 4 (2015), p. 1317-1323
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- Description: Sulfadoxine-pyrimethamine (SP) plus azithromycin (AZ) (SPAZ) has the potential for intermittent preventive treatment of malaria in pregnancy (IPTp), but its use could increase circulation of antibiotic-resistant bacteria associated with severe pediatric infections. We evaluated the effect of monthly SPAZ-IPTp compared to a single course of SP plus chloroquine (SPCQ) on maternal nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus at delivery among 854 women participating in a randomized controlled trial in Papua New Guinea. Serotyping was performed, and antibiotic susceptibility was evaluated by disk diffusion and Etest. Potential risk factors for carriage were examined. Nasopharyngeal carriage at delivery of S. pneumoniae (SPAZ, 7.2% [30/418], versus SPCQ, 19.3% [84/436]; P < 0.001) and H. influenzae (2.9% [12/418] versus 6.0% [26/436], P = 0.028), but not S. aureus, was significantly reduced among women who had received SPAZ-IPTp. The number of macrolide-resistant pneumococcal isolates was small but increased in the SPAZ group (13.3% [4/30], versus SPCQ, 2.2% [2/91]; P = 0.033). The proportions of isolates with serotypes covered by the 13-valent pneumococcal conjugate vaccine were similar (SPAZ, 10.3% [3/29], versus SPCQ, 17.6% [16/91]; P = 0.352). Although macrolide-resistant isolates were rare, they were more commonly detected in women who had received SPAZ-IPTp, despite the significant reduction of maternal carriage of S. pneumoniae and H. influenzae observed in this group. Future studies on SPAZ-IPTp should evaluate carriage and persistence of macrolide-resistant S. pneumoniae and other pathogenic bacteria in both mothers and infants and assess the clinical significance of their circulation.
Evaluation of a rapid immunochromatographic assay for the detection of rotavirus, norovirus and adenovirus from children hospitalized with acute watery diarrhea
- Authors: Kas, Monalisa , Maure, Tobias , Soli, Kevin , Umezaki, Masahiro , Morita, Ayako , Bebes, Sauli , Jonduo, Marinjho , Larkins, Jo-Ann , Luang-Suarkia, Dagwin , Siba, Peter , Greenhill, Andrew , Horwood, Paul
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea Medical Journal Vol. 56, no. 3-4 (2013), p. 141-144
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- Description: We evaluated the IP-Triple I immunochromatographic rapid test for the detection of rotavirus, norovirus and adenovirus using stool samples from children with diarrhoea. The detection of norovirus and adenovirus was poor compared to polymerase chain reaction assays. However, high sensitivity (92%) and specificity (99%) were obtained for the detection of rotavirus.
Evaluation of a WASH intervention demonstrates the potential for improved hygiene practices in Hiri District, Central Province
- Authors: Phuanukoonnon, Suparat , Namosha, Elias , Kua, Lydia , Siba, Peter , Greenhill, Andrew
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea medical journal Vol. 56, no. 3-4 (2013), p. 126-135
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- Description: Water, sanitation and hygiene (WASH) interventions aim to improve health outcomes through provision of safe water supplies and improved sanitation facilities, while also promoting better hygiene practices in communities. Population Services International introduced a WASH intervention project in the Hiri District, Central Province in May 2012. Shortly after its introduction we conducted a survey to determine the uptake of the intervention and gauge its impact. We invited 400 households to participate in the study, which consisted of a questionnaire for the head of the household. A total of 395 questionnaires were completed: 314 from households that had participated in the WASH intervention and 81 that had not (controls). Results demonstrated that improved water sources were not routinely used, with a high dependence on well and surface water. While self-reported handwashing was common, use of soap was not common. Treatment of water inside the house was common in the intervention group (95%), compared to 49% in the non-WASH group. The study indicates that people in the Hiri District are supportive of a WASH intervention, with good uptake of some aspects of the intervention. The sustainability of the intervention remains unknown. Targetted interventions focusing on community priorities might be beneficial in the future.
Isolation of Vibrio cholerae and other enteric microbiota from patients with suspected cholera during the 2009 outbreak in Madang Province, Papua New Guinea
- Authors: Kas, Monalisa , Horwood, Paul , Laman, Moses , Manning, Laurens , Atua, Vincent , Siba, Peter , Greenhill, Andrew
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea medical journal Vol. 56, no. 3-4 (2013), p. 110-115
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- Description: When cholera was first detected in Papua New Guinea (PNG) in mid-2009, national diagnostic capacity faced many challenges. This was in part due to the non-endemic status of the outbreak, resulting in few local staff experienced in Vibrio cholerae detection and poor access to the required consumables. The PNG Institute of Medical Research conducted culture on specimens from suspected cholera patients in Madang Province, with presumptive V. cholerae isolates sent to Goroka for confirmation. Of 98 samples analysed 15 were culture positive, with V. cholerae detected by polymerase chain reaction (PCR) in an additional 3 samples. Further analyses were conducted to identify other pathogenic bacteria from thiosulphate citrate bile salt sucrose (TCBS) agar. Molecular-based assays detected enteropathogenic (n = 1) and enterotoxigenic (n = 1) strains of Escherichia coli. No other major enteric pathogens were detected. The low detection rate of V. cholerae at the provincial level reflects challenges in the laboratory diagnosis of cholera and in-country challenges in responding to an outbreak of a non-endemic disease, such as lack of in-country diagnostic expertise and available consumables in the early stages. It also suggests that full aetiological investigations are warranted in future outbreaks of acute watery diarrhoea in PNG to fully elucidate the potentially complex aetiology, which could in turn guide diagnostic, treatment and prevention measures.
Bloodstream infections caused by resistant bacteria in surgical patients admitted to Modilon Hospital, Madang
- Authors: Asa, Henao , Laman, Moses , Greenhill, Andrew , Siba, Peter , Davis, Timothy , Maihua, John , Manning, Laurens
- Date: 2012
- Type: Text , Journal article
- Relation: Papua and New Guinea Medical Journal Vol. 55, no. 1-4 (2012), p. 5-11
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- Description: In view of the dearth of information relating to antibiotic resistance in community- and hospital-acquired bacterial infections in Papua New Guinea (PNG), we carried out a prospective, hospital-based observational study of surgical patients between October 2008 and October 2009. In a sample of 115 patients (median age 30 years; 55% males) suspected of having a bloodstream infection, blood cultures were positive in 11 (10%) and a significant pathogen was isolated in 9 (8%). Staphylococcus aureus was isolated in 4 patients (44%) and 3 were methicillin resistant; all these isolates were considered community acquired because cultures were performed within 48 hours of admission. Of the remaining 5 isolates, 4 were Gram-negative organisms with at least intermediate resistance to chloramphenicol that were grown from blood taken > 48 hours post-admission and thus considered nosocomially acquired. These data suggest two distinct patterns of bacterial infection in PNG surgical inpatients that have implications for national antibiotic prescription guidelines.
Predictors of acute bacterial meningitis in children from a malaria-endemic area of Papua New Guinea
- Authors: Laman, Moses , Manning, Laurens , Greenhill, Andrew , Mare, Trevor , Michael, Audrey , Shem, Silas , Vince, John , Lagani, William , Hwaihwanje, Ilomo , Siba, Peter , Mueller, Ivo , Davis, Timothy
- Date: 2012
- Type: Text , Journal article
- Relation: American Journal of Tropical Medicine and Hygiene Vol. 86, no. 2 (2012), p. 240-245
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- Description: Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2-10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig's and Brudzinski's signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) ≥ 4.3 for proven/probable ABM. Multiple seizures and deep coma were less predictive (LR = 1.5-2.1). Single seizures and malaria parasitemia had low LRs (≤ 0.5). In logistic regression including clinical variables, Kernig's sign and deep coma were positively associated with ABM, and a single seizure was negatively associated (P ≤ 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM (P ≤ 0.04). In young children, a bulging fontanel added to the model (P < 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.
Multilocus sequence typing of Streptococcus pneumoniae by use of mass spectrometry
- Authors: Dunne, Eileen , Ong, Engkok , Moser, Ralf , Siba, Peter , Phuanukoonnon, Suparat , Greenhill, Andrew , Robins-Browne, Roy , Mulholland, Edward , Satzke, Catherine
- Date: 2011
- Type: Text , Journal article
- Relation: Journal of Clinical Microbiology Vol. 49, no. 11 (2011), p. 3756-3760
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- Description: Multilocus sequence typing (MLST) is an important tool for the global surveillance of bacterial pathogens that is performed by comparing the sequences of designated housekeeping genes. We developed and tested a novel mass spectrometry-based method for MLST of Streptococcus pneumoniae. PCR amplicons were subjected to in vitro transcription and base-specific cleavage, followed by analysis of the resultant fragments by using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Comparison of the cleavage fragment peak patterns to a reference sequence set permitted automated identification of alleles. Validation experiments using 29 isolates of S. pneumoniae revealed that the results of MALDI-TOF MS MLST matched those obtained by traditional sequence-based MLST for 99% of alleles and that the MALDITOF MS method accurately identified two single-nucleotide variations. The MADLI-TOF MS method was then used for MLST analysis of 43 S. pneumoniae isolates from Papua New Guinean children. The majority of the isolates present in this population were not clonal and contained seven new alleles and 30 previously unreported sequence types.